Provider Demographics
NPI:1306206719
Name:DOYLE, REBECCA RAELYN (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAELYN
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 N 350 W
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:UT
Mailing Address - Zip Code:84015-3513
Mailing Address - Country:US
Mailing Address - Phone:337-353-6166
Mailing Address - Fax:
Practice Address - Street 1:209 E GORDON AVE
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2341
Practice Address - Country:US
Practice Address - Phone:801-200-1574
Practice Address - Fax:801-513-5608
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10432335-2506103K00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst